Cost burden of post-transplant lymphoproliferative disease following kidney transplants in Medicare-eligible patients by survival status

Figures & data

Figure 1. Part A + B Medicare costs by year after transplant. Part B costs consisted of office visit and durable medical equipment claims. Abbreviations. n, number of patients; PPY, per patient-year; PTLD, post-transplant lymphoproliferative disease.

Table 1. Medicare payments by time from PTLD diagnosis^a.

	3–6 months before PTLD diagnosis			3 months before PTLD diagnosis			Year 1 after PTLD diagnosis			Year 2 after PTLD diagnosis
	(patient-years: 85.23)			(patient-years: 87.39)			(patient-years: 238.36)			(patient-years: 145.78)
Cost source	n	Total	PP3M (95% CI)	n	Total	PP3M (95% CI)	n	Total	PPY (95% CI)	n	Total	PPY (95% CI)
Parts A + B	350	$2,554,581	$7,493	356	$4,317,560	$12,351	347	$34,770,005	$145,871	175	$5,873,253	$40,289
			($6,747–$8,233)			($11,152–$13,902)			($137,667–$156,113)			($36,476–$44,922)
Part A inpatient	60	$775,931	$2,276	109	$1,905,052	$5,450	289	$21,013,718	$88,159	79	$2,468,721	$16,935
			($1,599–$2,897)			($4,422–$7,055)			($80,286–$98,225)			($13,513–$21,368)
Part A outpatient	313	$689,090	$2,021	337	$825,439	$2,361	312	$6,146,166	$25,785	170	$1,346,740	$9,238
			($1,657–$2,495)			($2,070–$2,731)			($24,320–$27,737)			($8,487–$10,099)
Part A home health	25	$77,815	$228	30	$71,079	$203	107	$509,153	$2,136	33	$194,611	$1,335
			($164–$323)			($150–$276)			($1,732–$2,551)			($1,061–$1,614)
Part A hospice	*	*	*	*	*	*	30	$143,057	$600	12	$44,418	$305
									($430–$797)			($131–$479)
Part A skilled nursing	*	*	*	*	*	*	52	$871,714	$3,657	14	$149,470	$1,025
									($3,014–$4,419)			($476–$1,546)
Part B	347	$950,801	$2,789	353	$1,492,662	$4,270	344	$6,086,197	$25,533	171	$1,669,292	$11,451
			($2,665–$2,913)			($4,126–$4,416)			($24,767–$26,467)			($10,968–$12,042)

*Values for cells with 10 or fewer patients are suppressed. ^a347 Medicare-covered PTLD patients were identified who had at least one claim within a year of PTLD diagnosis; however, additional patients may have a PTLD diagnosis without a subsequent claim and data prior to their PTLD diagnosis. Part B costs consisted of office visit and durable medical equipment. Abbreviations. CI, confidence interval; n, number of patients; PP3M; per patient-3 months; PPY, per patient-year; PTLD, post-transplant lymphoproliferative disease.

Table 2. HRU by time from PTLD diagnosis^a.

Expenditure category	3–6 months before PTLD diagnosis	3 months before PTLD diagnosis	Year 1 after PTLD diagnosis	Year 2 after PTLD diagnosis
Inpatient
Patients at risk (n)	472	474	350	179
Patients with claims (n, % of patients with claims)	44 (9.32)	68 (14.35)	240 (68.57)	53 (29.61)
Claims per patient (mean, SD)	0.12, 0.40	0.18, 0.49	1.93, 2.40	0.51, 1.02
Outpatient
Patients at risk (n)	472	474	350	179
Patients with claims (n, % of patients with claims)	350 (74.15)	356 (75.11)	341 (97.43)	174 (97.21)
Claims per patient (mean, SD)	23.01, 25.62	30.57, 33.39	118.55, 103.47	88.47, 79.25
Dialysis
Patients at risk (n)	*	*	17	14
Patients with claims (n, % of patients with claims)	*	*	12 (70.59)	12 (85.71)
Claims per patient (mean, SD)	*	*	4.29 (3.77)	6.43 (5.52)
ER
Patients at risk (n)	475	474	350	179
Patients with claims (n, % of patients with claims)	72 (15.25)	165 (34.81)	185 (52.86)	91 (50.84)
Claims per patient (mean, SD)	0.37, 1.02	0.93, 1.74	2.18, 3.23	2.18, 3.71

*Values for cells with 10 or fewer patients are suppressed. ^a347 Medicare-covered PTLD patients were identified who had at least one claim within a year of PTLD diagnosis; however, additional patients may have a PTLD diagnosis without a subsequent claim and data prior to their PTLD diagnosis. Abbreviations. ER, emergency room; HRU, healthcare resource use; n, number of patients; PTLD post-transplant lymphoproliferative disease; SD, standard deviation.

Table 3. Medicare payments by survival status at 2 years after PTLD diagnosis^a.

	Died within 2 years (patient-years: 66.36)			Alive at 2 years (patient-years: 320.85)
Cost source	n	Total	PPY	n	Total	PPY
			(95% CI)			(95% CI)
Parts A + B	133	$16,579,384	$249,850	214	$24,063,874	$75,001
			($227,533–$275,227)			($70,793–$79,628)
Part A inpatient	128	$11,317,259	$170,550	171	$12,165,181	$37,916
			($148,720–$195,081)			($33,809–$42,309)
Part A outpatient	103	$1,632,407	$24,600	209	$5,860,500	$18,266
			($22,447–$27,029)			($17,129–$19,447)
Part A home health	48	$282,397	$4,256	67	$421,366	$1,313
			($3,336–$5,207)			($1,097–$1,543)
Part A hospice	40	$187,475	$2,825	*	*	*
			($2,059–$3,678)
Part A skilled nursing	33	$542,279	$8,172	25	$478,905	$1,493
			($6,232–$10,302)			($1,091–$1,894)
Part B	131	$2,617,567	$39,447	213	$5,137,922	$16,014
			($38,171–$41,156)			($15,564–$16,488)

*Values for cells with 10 or fewer patients are suppressed. ^a347 Medicare-covered PTLD patients were identified who had at least one claim within a year of PTLD diagnosis; however, additional patients may have a PTLD diagnosis without a subsequent claim and data prior to their PTLD diagnosis. Part B costs consisted of office visit and durable medical equipment claims. Abbreviations. CI, confidence interval; n, number of patients; PPY, per patient-year; PTLD, post-transplant lymphoproliferative disease.

Table 4. Part A + B Medicare payments in PTLD patients who died within 2 years of diagnosis by time of death^a.

PTLD population	n	PPM (95% CI)	PP6M (95% CI)	PPY (95% CI)
Died within 6 months (patient-years: 15.29)	86	$41,674 ($35,956–$49,493)	$250,045 ($215,737–$296,958)	$500,090 ($431,475–$593,917)
Died in 6 months to 1 year (patient-years: 15.03)	21	$4,956 ($3,611–$6,677)	$29,736 ($21,665–$40,060)	$59,472 ($43,330–$80,120)
Died in 1–2 years (patient-years: 36.03)	26	$4,123 ($3,016–$5,718)	$24,738 ($18,093–$34,310)	$49,476 ($36,187–$68,620)

^a347 Medicare-covered PTLD patients were identified who had at least one claim within a year of PTLD diagnosis; however, additional patients may have a PTLD diagnosis without a subsequent claim and data prior to their PTLD diagnosis. Part B costs consisted of office visit and durable medical equipment claims. Abbreviations. CI, confidence interval; n, number of patients; PP6M, per patient-6 months; PPM, per patient-month; PPY, per patient-year; PTLD, post-transplant lymphoproliferative disease.